INTRODUCTION TO RESPIRATORY BLOCK

Modes of teaching Teaching of this block contents will be in the form of : Lectures problem based learning Practicals.

ANATOMY & HISTOLOGY OF NASAL CAVITY & PHARYNX – Nasal cavity: boundaries, lateral wall. – Paranasal sinuses: names, functions, openings. – Pharynx: parts. – Microscopic structures of: vestibule of nose, respiratory & olfactory mucosa, nasal septum, mucosa of paranasal sinuses, larynx.. MUSCLES INVOLVED IN NORMAL RESPIRATION - Bones and joints of thoracic cage. - Respiratory movements - Inspiratory & expiratory muscles. ANATOMY OF LARYNX, TRACHEA & BRONCHI - Larynx & trachea: extent, structure & functions. - Bronchial tree: structure, subdivisions & functions. EMBRYOLOGY OF RESPIRATORY SYSTEM - Important notes in development of larynx, trachea & lung. ANATOMY OF PLEURA & LUNG - Pleura: subdivisions, recesses, surface anatomy, supply. - Lungs: shape, relations, supply. - Difference between right & left lungs. HISTOLOGY OF LUNG & BRONCHIAL TREE - Microscopic structures of the wall of: trachea, bronchi, bronchioles, pleura. RADIOLOGICAL ANATOMY OF CHEST – Postero-anterior radiograph of chest. – Postero-anterior bronchogram. – Lateral radiograph of chest, after barium swallow. – Coronary angiogram. MEDIASTINUM - Definition, subdivisions, boundaries & contents of each mediastinum.

Introduction Prof.Kambal Ishfaq Bukhari, Dr. Reem Sallam and other members of the block committee

The Respiratory Module is a 4 week With the following major learning objectives. 1. Understand normal structure and function of the Respiratory system. 2. Describe the etiology and the pathogenesis of common respiratory disorders (Broncila asthma, Allergy, COPD, respiratory tract infections and pulmonary tuberculosis). 3. Correlate clinical features to the pathophysiology of the disease. 4. Take a relevant history and perform a clinical examination to diagnose respiratory tract disorders. 5. Plan out investigations to diagnose and manage respiratory disorders. 6. Describe principles of the pharmacological basis in the treatment of respiratory disorders (Broncila asthma, Allergy, COPD, respiratory tract infections and pulmonary tuberculosis). 8. Describe cigarette smoking problems and their solution. 9. Describe the basic management of the respiratory disorders 10. Be able to diagnose, manage and counsel patients with respiratory disorders

 Pharmacotherapeutic profile of anticholinergic and agrenergic drugs  Pharmacology of various classes of drugs used in the management of Asthma and COIPD.  Drugs used in the management of anaphylaxis, cough and rhinitis.  General concept of antibiotics and rational of the use of antibiotics in respiratory tract infections.  Pharmacotherapy of Tubercolosis, mechanism, selection and safety profile of Anti-TB drugs.

Lec 1: Globular Proteins Upon completion of this lecture, students should be able to:  understand what are globular proteins; their types & functions; with special emphasis on hemoglobin, myoglobin, & globulins  be familiar with Diseases associated with globular proteins Lec 2: Phospholipid (PL) Compounds of Physiological Importance In this lecture, students will be introduced to the following: Selected members of PLs Physiological importance of PLs Lung surfactant: structure, function, & clinical application. Types and functions of Plospholipases Lec 3: Respiratory Chain Upon completion of this lecture, students should be able to: understand how Energy-rich molecules are metabolized by a series of oxidation reactions. be familiar with the process of electron transport chain and the relevant reactions taking place in mitochondria.

RESPIRATORY PHYSIOLOGY (BLOCK) Functions and Organization of the Respiratory System Mechanics of breathing Respiratory ventilation Lung Function in Health and disease Gas Exchange and Gas Transfer Oxygen and Carbon dioxide Transport Hypoxia and cyanosis Control of breathing Effects of low and high gas pressure on the body Effects of exercise on the respiratory system

RESPIRATORY BLOCK (OBJECTIVES AND PATHOLOGY LECTURES CONTENTS) Number of Lectures: 5 Number of Practicals: 2 Tutors: Dr. Ammar Al-Rikabi (male students) – Dr. Maha Arafah (female students ) - Dr. Marie (male practicals) Dr. Shaesta Zaidi (female practicals) –

LECTURE ONE : Pathology and pathogenesis of bronchial asthma. OBJECTIVES: At the end of this lecture, the student should be capable of: A]Understanding asthma as an episodic, reversible bronchoconstriction caused by increased responsiveness of the tracheobronchial tree to various stimuli. B]Knowing that asthma is divided into two basic types: extrinsic or atopic allergic and intrinsic asthma. C]Understanding the morphological changes seen in the lungs in cases of severe asthma.

CONTENTS: 1]Definitions of asthma as one of the chronic obstruction airway diseases. 2]Types and pathogenesis of extrinsic (immune) asthma and extrinsic (non-immune) asthma. 3]Clinical presentation and pathological changes seen in the bronchial tree in cases of asthma. 4]Complications of asthma: superimposed infection, chronic bronchitis and pulmonary emphysema. 5]Definition and manifestations of status asthmaticus.

LECTURE TWO: : Chronic obstructive airway diseases: chronic bronchitis, emphysema and bronchiectasis. OBJECTIVES: At the end of this lecture, the students should be able to: A]Understand that this group of disorders is characterized by an increase in resistance to airflow, owing to partial or complete obstruction at any level of the bronchial/bronchiolar. B]Know that the major obstructive disorders are chronic bronchitis, emphysema, asthma and bronchiectasis. C]Is aware that the symptom common to all these disorders is "dyspnea" (difficulty in breathing) but each have their own clinical and anatomical characteristics. D]Chronic bronchitis and emphysema almost always coexists.

CONTENTS: 1]Chronic bronchitis: definition, clinical presentation, role of cigarette smoking and air pollution, pathological changes and complications with special emphasis on cor pulmonale. 2]Emphysema: definition and clinical characteristics. Types of emphysema including centrilobular emphysema, panacinar emphysema (deficiency of alpha one antitrypsin), paraseptal and irregular emphysema. 3]Complications of emphysema with special emphasis on interstitial emphysema and pneumothorax. 4]Bronchiectasis: definition, predisposing factors, kartagener's syndrome (primary ciliary dyskinesia) and pathological features of bronchiectasis.

LECTURE THREE: Restrictive lung diseases. OBJECTIVES: At the end of this lecture, the student should be able to: A]Understand the structure and constituents of the lung interstitium as well as the restrictive changes which occur in these diseases and lead to the development of symptoms of progressive breathlessness and cough in affected patients. B]Appreciate the pathogenesis of interstitial lung diseases regardless of their type. This pathogenesis include the influx of inflammatory cells into the alveoli and alveolar walls, distortion of the normal structure of alveoli, release of chemical mediators and promotion of fibrosis (honey-comb lung). C]Become aware of the classification of interstitial lung diseases.

CONTENTS: 1]Definition and causes of restrictive pulmonary diseases. 2]Pathogenesis of restrictive pulmonary diseases which include abnormalities in the chest wall or neuromuscular diseases that restrict lung expansion or conditions leading to interstitial accumulations of cells or non-cellular substances. 3]Brief account on the clinicopathological features of: Adult and neonatal respiratory distress syndromes. Anthracosis and coal worker's pneumoconiosis. Silicosis and asbestosis. Hypersensitivity pneumonitis (extrinsic allergic alveolitis). Goodpasture syndrome. Eosinophilic granuloma. Idiopathic pulmonary fibrosis. Sarcoidosis.

LECTURE FOUR: TUBERCULOSIS OBJECTIVES At the end of this lecture, the student should be able to: A] Define tuberculosis. B] List organs that are commonly affected by tuberculosis. C] Epidemiology of Tuberculosis. D] Recognize the morphology of Mycobacteria. E] Recognize different phases of tuberculosis F] Know the basis and use of tuberculin skin (Mantoux) test. G] List the common clinical presentations, complications and prognosis of tuberculosis.

CONTENTS: 1] Definition and causes of Tuberculosis including its epidemiology. 2] Pathogenesis of granuloma formation and its morphology. 3] In regard to Mycobacterial lung infection: Compare and contrast the following in relation to their gross and histologic lung pathology: primary tuberculosis (include a definition of the Ghon complex). secondary or reactivation tuberculosis. miliary tuberculosis. 4] Brief account on the clinicopathological features of tuberculosis. 5] Diagnosis and the basis of tuberculin skin (Mantoux) test. 6] Brief account on the complications and prognosis of tuberculosis.

LECTURE FIVE: Pathology of lobar pneumonia and bronchopneumonia. OBJECTIVES: At the end of this lecture, the student should be able to: A]Understand that pneumonia is an inflammatory condition of the lung characterized by consolidation (solidification) of the pulmonary tissue. B]Is aware of the pathogenesis of pneumonia and its classification which principally include bronchopneumoniae, lobar pneumonia and atypical pneumonia. C]Is able to appreciate the aetiology and pathogenesis of lung abscess.

CONTENTS: 1]General considerations and clinical characteristics of pneumonia. 2]Morphologic types of pneumonias including lobar pneumonia, bronchopneumonia and interstitial pneumonia (atypical pneumonia) with special emphasis on mycoplasma pneumonia, viral pneumonia and ornithosis (Chlamydia induced). 3]Pneumocystis carinii pneumonia as the most common opportunistic infection in patients with AIDS. 4]Hospital acquired gram negative pneumonias. 5]Lung abscess: causes and manifestations.

LECTURE SIX: TUMOURS OF THE LUNG OBJECTIVES: At the end of this lecture, the student should be able to: A]Understand the incidence, age group of affected patients and predisposing factors of bronchogenic carcinoma. B]Is aware of the classification of bronchogenic carcinoma which include: squamous carcinoma, adenocarcinoma, small cell and large cell (anaplastic) carcinomas. C]Understands the clinical features and gross pathology of bronchogenic carcinoma. D]Have a basic knowledge about neuroendocrine tumours with special emphasis on small cell carcinoma and bronchial carcinoid. E]Is aware that the lung is a frequent site for metastatic neoplasms.

CONTENTS: 1]Bronchogenic carcinoma: aetiology, epidemiology, clinical features including superior Vena Cava syndrome, pancoast tumour, hoarseness, pleural effusion and paraneoplastic endocrine syndromes. 2]Types, location and clinicopathological characteristics of squamous cell carcinoma, adenocarcinoma, bronchioloalveolar carcinoma, small cell carcinoma, large cell carcinoma, carcinoid tumour and metastatic carcinoma to the lung. 3]Primary and secondary tumours of the pleura.

Immunology Unit (Two Lectures) Lecturers:Dr. Adel Almogren Prof. Zahid Shakoor Immunology of bronchial asthma Allergens in induction of allergic inflammation Cytokines in pathogenesis of asthma Airway remodeling in asthma Immunology of tuberculosis Immune handling of M. tuberculosis Cytokines and TB Tuberculin test Prof. Zahid Shakoor Immunology Unit

Microbiology (Prof. Kambal) Tuberculosis Causative agents mycobacterium tuberculosis complex (MTBC) Non tuberculosis mycobacterium (NTM) Difference between MTBC & NTM Morphology differences Culture methods Susceptibility Testing Importance of tuberculosis as a mainly respiratory diseases Cause of Upper Respiratory Tract Infection Importance of sore throat by group A and and its complications. Viral causes of Respiratory Tract Infection - Influenza, Rhinoviruses etc. Fungal causes of Respiratory Infection. Commonly acquired pneumonia (bacterial cause). Hospital acquired pneumonia caused by multidrug resistant bacteria.